期望对腰椎间盘突出症治疗结果的影响
Effect of Expectations on Treatment Outcome for Lumbar Intervertebral Disc Herniation.
作者信息
Lurie Jon D, Henderson Eric R, McDonough Christine M, Berven Sigurd H, Scherer Emily A, Tosteson Tor D, Tosteson Anna N A, Hu Serena S, Weinstein James N
机构信息
*The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College†Department of Orthopaedics‡Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH§Department of Orthopaedics, University of California, San Francisco¶Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth||Dartmouth-Hitchcock Medical Center, Lebanon, NH.
出版信息
Spine (Phila Pa 1976). 2016 May;41(9):803-9. doi: 10.1097/BRS.0000000000001333.
STUDY DESIGN
Secondary analysis of randomized and nonrandomized prospective cohorts.
OBJECTIVE
To examine the effect of patient treatment expectations on treatment outcomes for patients with intervertebral disc herniation.
SUMMARY OF BACKGROUND DATA
Patient expectations about treatment effectiveness may have important relationships with clinical outcomes.
METHODS
Subgroup and reanalysis of the Spine Patient Outcomes Research Trial, a randomized trial and comprehensive cohort study enrolling patients between March 2000 and November 2004 from 13 multidisciplinary spine clinics in 11 US states. Overall, 501 randomized and 744 observational patients (1244 total) who were surgical candidates with radiculopathy and imaging confirmed lumbar intervertebral disc herniation were enrolled. The primary study compared surgical discectomy to usual nonoperative care; this subgroup analysis reassessed outcomes on the basis of treatment expectations at baseline. Expectations about symptomatic and functional improvement for both surgery and nonoperative care were assessed on 5-point scales (1="No Chance (0%)" to 5="Certain (100%)"). Outcomes were assessed using longitudinal regression models analyzed by treatment received.
RESULTS
Among 1244 IDH SPORT participants, 1168 provided data on both outcomes and baseline expectations and were included in the current analysis: 467 from the randomized and 701 from the observational cohort. Low expectations of outcomes with surgery predicted poorer outcome regardless of treatment. High expectations of outcomes with nonoperative care predicted better nonoperative outcomes but did not affect surgical results. These differences were of similar magnitude to the difference in outcomes between surgery and nonoperative care.
CONCLUSION
High expectations of treatment benefit had clinically significant positive associations with outcomes.
LEVEL OF EVIDENCE
研究设计
对随机和非随机前瞻性队列进行二次分析。
目的
探讨患者治疗期望对椎间盘突出症患者治疗结果的影响。
背景数据总结
患者对治疗效果的期望可能与临床结果有重要关系。
方法
对脊柱患者预后研究试验进行亚组分析和再分析，该试验是一项随机试验和综合队列研究，于2000年3月至2004年11月在美国11个州的13个多学科脊柱诊所招募患者。总体而言，纳入了501名随机分组患者和744名观察性患者（共1244名），这些患者均为有神经根病且影像学证实为腰椎间盘突出症的手术候选者。主要研究将手术椎间盘切除术与常规非手术治疗进行比较；该亚组分析根据基线时的治疗期望重新评估结果。通过5分制量表（1 =“无机会（0%）”至5 =“肯定（100%）”）评估对手术和非手术治疗的症状和功能改善的期望。使用纵向回归模型根据接受的治疗进行分析来评估结果。
结果
在1244名椎间盘突出症患者预后研究试验参与者中，1168名提供了有关结果和基线期望的数据，并被纳入当前分析：467名来自随机分组队列，701名来自观察性队列。对手术结果的低期望预示着无论接受何种治疗，结果都较差。对非手术治疗结果的高期望预示着非手术治疗效果更好，但不影响手术结果。这些差异的大小与手术和非手术治疗结果之间的差异相似。
结论
对治疗益处的高期望与结果具有临床上显著的正相关。
证据级别
2级。
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